A number of trends have recently combined to focus attention on elderly victims of trauma and burns. The elderly are the fastest growing segment of the US population, and this will continue during the next 50 years. Traumatic injury in all ages has been recognized as a neglected disease in America, and recent emphasis has been placed on trauma research and clinical care. Government funding is setting the trend for health care financing, but reimbursement in woefully inadequate for trauma patients, particularly the elderly, who comprise only 5% of trauma admissions, yet constitute 25% of trauma deaths, and consume over one-third of the resources expended for trauma care. Burn injuries are particularly common among older Americans, whose care is becoming increasingly costly as survival from large injuries improves. At the same time, recent evidence has documented good functional recovery from burn injury in the elderly. This suggests that continued expenditures for burn care in this group are appropriate, and underscores the need for further improvements in the care of elderly burn victims. This need has been frustrated, however, by a remarkable death of information regarding many outcomes of burn injury, including physiologic response, psycho-social adjustments, and true costs of care. For all these reasons, elderly burn patients exemplify dilemmas regarding rational usage of health care resources in an era of cost-consciousness. The present application represents continuation of a longitudinal study designed to define and quantify outcomes of thermal injury in elderly (age 45 and over) and younger adults. All adult patients admitted for the treatment of acute burns will be followed through recovery, and a number of outcomes will be assessed. Physiologic response will be measured by mortality rates, and the frequency and severity of multiple organ failure (MOF), measured with the Thermal Injury Organ Failure (TIOF), and APACHE-II scoring systems. Because of recent work emphasizing the importance of circulating serum factors in the response to burn injury, Cytokine kinetics will be assessed by serial determinations of cytokine levels, and the relationship of cytokine profiles to clinical events will be described. Psychosocial adjustments to injury will be assessed by a battery of standardized social and psychological scales, and results correlated with long-term outcomes, including length of hospital stay, compliance with therapy, and function post-injury. Finally, costs of care, including direct and indirect expenses, will be tabulated. For each component, results will be analyzed in an effort to design therapies aimed at optimizing oxygen delivery (DO2) and resolution of shock in the immediate post-burn period will be conducted. The efficacy of this regimen will be examined, and further tested in a randomized trial if appropriate. This grant is submitted in response to program announcement number 912 from the Department of Health and Human Services/Centers for Disease Control, and deals most specifically with acute care.